Self-learning
Systemic Lupus Erythematosus (SLE)
Definition
Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease,
the immune system of the body mistakenly attacks healthy tissue. It can affect
the skin, joints, kidneys, brain, and other organs.
Causes
The cause of SLE is not clearly known. It may be linked to the following factors:
Genetic
Environmental
Hormonal
Certain medicines
SLE is more common in women than men by nearly 10 to 1. It may occur at any
age. However, it appears most often in young women between the ages of 15 and
44.
Symptoms
Symptoms vary from person to person, and may come and go. Everyone with
SLE has joint pain and swelling at some time. Some develop arthritis. SLE often
affects the joints of the fingers, hands, wrists, and knees.
Other common symptoms include:
Chest pain when taking a deep breath.
Fatigue.
Fever with no other cause.
General discomfort, uneasiness, or ill feeling (malaise).
Hair loss.
Weight loss.
Mouth sores.
Sensitivity to sunlight.
Skin rash -- A "butterfly" rash develops in about half the people with SLE. The
rash is mostly seen over the cheeks and bridge of the nose. It can be widespread.
It gets worse in sunlight.
Swollen lymph nodes.
Other symptoms and signs depend on which part of the body is affected:
Brain and nervous system -- Headaches, weakness, numbness, tingling, seizures,
vision problems, memory and personality changes
Digestive tract -- Abdominal pain, nausea, and vomiting
Heart -- Valve problems, inflammation of heart muscle or heart lining
(pericardium)
Lung -- Buildup of fluid in the pleural space, difficulty breathing, coughing up
blood
Skin -- Sores in the mouth
Kidney -- Swelling in the legs
Circulation -- Clots in veins or arteries, inflammation of blood vessels,
constriction of arteries in response to cold (Raynaud phenomenon)
Blood abnormalities including anemia, low white blood cell or platelet count
Some people have only skin symptoms. This is called discoid lupus.
Exams and Tests
Tests used to diagnose SLE may include:
Antinuclear antibody (ANA)
Complete blood count (CBC) with differential
Chest x-ray
Serum creatinine
Urinalysis
You may also have other tests to learn more about your condition. Some of these
are:
Antinuclear antibody (ANA) panel
Complement components (C3 and C4)
Antibodies to double-stranded DNA
Coombs test -- direct
Cryoglobulins
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
Kidney function blood tests
Liver function blood tests
Rheumatoid factor
Antiphospholipid antibodies and lupus anticoagulant test
Kidney biopsy
Imaging tests of the heart, brain, lungs, joints, muscles or intestines
Treatment
There is no cure for SLE. The goal of treatment is to control symptoms.
Mild forms of the disease may be treated with:
Nonsteroidal anti-inflammatory drugs (NSAIDs) for joint symptoms and
pleurisy.
Low doses of corticosteroids, such as prednisone, for skin and arthritis
symptoms.
Corticosteroid creams for skin rashes.
Hydroxychloroquine, a medicine also used to treat malaria.
Methotrexate may be used to reduce the dose of corticosteroids.
Belimumab and anifrolumab are biologic medicines that may be helpful in some
people.
Treatments for more severe SLE may include:
High-dose corticosteroids.
Immunosuppressive medicines (these medicines suppress the immune system).
These medicines are used if you have severe SLE that is affecting your nervous
system, kidney, or other organs. They may also be used if you do not get better
with corticosteroids, or if your symptoms get worse when you stop taking
corticosteroids.
Medicines most commonly used include mycophenolate, azathioprine,
cyclophosphamide, and valcosporin. Because of its toxicity, cyclophosphamide
is limited to a short course of 3 to 6 months. Rituximab is used in some cases as
well.
Blood thinners, such as warfarin (Coumadin), for clotting disorders such as
antiphospholipid syndrome.
If you have SLE, it is also important to:
Wear protective clothing, sunglasses, and sunscreen when in the sun.
Get preventive heart care.
Stay up-to-date with immunizations.
Have tests to screen for thinning of the bones (osteoporosis).
Avoid tobacco and drink minimal amounts of alcohol.